Some Still Struggling to Afford Affordable Care

April 23, 2014

David Ponce, who works at a veterainary hospital, wonders if his health plan, purchased on California’s exchange, will remain affordable. Photo: Pamela K. Johnson/CHR.

David Ponce, who works at a veterainary hospital in Long Beach, wonders if his health plan, purchased on California’s exchange, will remain affordable. Photo: Pamela K. Johnson/CHR.

By Pamela K. Johnson

Chanee Houston has decided to take her chances. As the open enrollment period for health insurance under Covered California closed this month, the 26-year-old remained uninsured.

The Irvine resident had considered purchasing a plan through the state’s marketplace, “but even with the financial aid they give you, it’s still kind of expensive,” she said. “I can’t spend $100 a month right now.”

More than 1.4 million people enrolled in a Covered California plan before the April 15 deadline, but some residents, such as Houston, feel that the Affordable Care Act still doesn’t provide them with affordable options. Others have signed up for health plans but wonder whether they’ll be able to pay the premiums or the out-of-pocket expenses associated with seeing a doctor.

Houston’s mother, Aileen Marshall, expressed worry for her daughter, who went to the emergency room fearing that she was having a heart attack six months ago. Houston was diagnosed with pleural effusion, a painful condition that led to excess fluid around her lungs and made it hard to breathe.

Marshall wanted her daughter to sign up for a Covered California plan to at least cover her until her new employer’s insurance kicks in sometime in May. “I would say look into it, but she feels like I’m telling her what to do,” Marshall said, as she got her hair styled at Twist N Shout salon in Long Beach earlier this month.

Covered but for how long?

Her hairstylist, Betty “BJ” Brandly, eagerly sign up for one of the plans. Before she enrolled a couple of months ago, she was among the cash-strapped Californians who went without insurance.

Over the last few years, Brandly used a roundabout way to access health care: She said she would go to a local research hospital and sign up for a study. Then, as a part of the evaluation process, doctors would give her a full physical before they told her what she already knew: She didn’t qualify.

They “would be doing a study, say, on arthritis,” Brandly said. “I got blood exams, my sugar levels, my cholesterol checked… It was better than going to (low-cost) clinics, where you often have to stand in a line that stretches around the block, feeling like a piece of meat.”

Before the economic recession hit, she had a regular physician, but as business slowed, “I cut back on things, and insurance was the first to go,” said Brandly, who owns the hair salon and is in her 50s. “I joined the gym instead; preventative care goes along way.”

She enrolled in Covered California early but has yet to see a doctor. She tried to get glasses recently, and was disappointed that her plan only knocked 10 percent off the full price. Having insurance does, however, contribute to her peace of mind, she said.

“If something were to happen (and I was uninsured), it would totally wipe me out. Now I sleep better at night.”

Brandly’s client, Melissa Hardaway, was a Covered California certified enrollment counselor. She estimates that she enrolled about 35 people in Covered California plans and another 75 people in Medi-Cal.

Single California adults with annual incomes below $15,856 qualify for Medi-Cal, the state’s low-income health program. Many middle-income adults above that threshold qualify for subsidies, but some still see the cost of insurance as prohibitive. Others, such as Brandly, have signed up for health plans but wonder whether the plans will be a good value for them or if premium rates will rise significantly next year, possibly making them unaffordable.

Confusion surrounds affordable plans

Hardaway helped Brandly, a second stylist in the salon, and a number of their clients decipher the enrollment process, which was confusing for many, she said.  One person she helped was undergoing chemotherapy for cancer, and was mistakenly told that she had to stop the therapy for six months because it was a result of a pre-existing condition. Hardaway intervened on her behalf, as Covered California plans allow for pre-existing conditions, straightened out the misunderstanding, and the woman resumed her cancer care.

David Ponce, an office manager at Beach Veterinary Hospital in Long Beach, also signed up for a Covered California plan with a pre-existing condition: asthma. He and his employer, who are on the same plan, chose it because their combined premiums were scheduled to rise. His portion would have gone up 15 to 20 percent to about $300.

So Ponce signed up for Covered California in the waning hours of March 31 — the state’s initial open-enrollment deadline, which was later extended to April 15.

He got a new insurance policy with a $150 monthly premium and became one of more than 400,000 Californians who signed up for the coverage in March, the highest single month of enrollment, according Covered California statistics.

Ponce, 36, who sees a doctor every few months to manage his asthma, said he’s grateful he found affordable insurance, and he hopes it will stay that way.

“I think it’s important to get care,” he said.  “You need the basics in life: You want a roof over your head, water and food, and health care, so you’re not scared of dying because you’re poor. That’s a horrible way to live, and I’ve lived like that for years.”

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